Factors determining survival in resected N2 lung cancer

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Abstract
This retrospective study was based on 237 patients with non-small celllung cancer (NSCLC) and nodal N2 disease. All accessible mediastinal lymphnodes (LN) were removed and classified according to their anatomicallocation in LN chains. The pulmonary resections performed were:pneumonectomy (n = 187), lobectomy (n = 44) and segmentectomy (n = 4).There was solitary nodal chain involvement by metastasis in 141 cases, twochains in 72 cases and three or more in 24; "skip" metastases were presentin 26.6%. N2 disease would have been missed in 45 cases of single chaininvolvement (31.9%) if routine removal of mediastinal nodes had not beenperformed. The overall 5-year survival rate was 18.8%. Survival was notinfluenced by site, size or extension (T) of tumor, tumor histology or thepresence of vascular invasion. The prognosis was significantly worsened bythe presence of microscopic residual disease (30 cases) and of satellitenodules (23 cases). Survival was significantly improved when metastasesinvolved a single LN chain (26.3 versus 8.3%, P = 0.0003). The location andnumber of involved nodes in the chain, "skip" metastases and the presenceof extracapsular spread of carcinoma did not influence the prognosis.Routine mediastinal LN dissection is necessary to improve survival and forclassification of lung cancer. Anatomic description allows betterunderstanding of N2 disease which is not a contraindication to surgery whena gross complete resection can be achieved.

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